AMY MARIE MACKIE Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004810

License Status

NOT RENEWED

Business

First Name

AMY

Middle

MARIE

Last Name

MACKIE

Business Name

AMY MARIE MACKIE

Original Issue Date

08/26/2013

Effective Date

03/16/2016

Expiration Date

03/01/2018

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Ever Disciplined

LastModifiedDate

05/10/2018